Appearance: Taking Control During Treatment

Treatments such as chemotherapy and radiation can damage a person's skin, hair, and nails. Many of these changes will go away after treatment ends. But such side effects, particularly hair loss, may also damage a person's spirits. Boston-based makeup artist and esthetician David Nicholas offered some of his beauty tips and the insight he has gained after working with cancer patients for more than 20 years.

Cancer Treatments: Getting Rid of Bad Cells as Well as Some Good Ones

These photos demonstrate what a person undergoing cancer treatment looks like with and without hair replacement, full makeup, and eyebrow enhancement (work by David Nicholas)

Treatments such as chemotherapy and radiation, designed to kill rapidly growing cancer cells, may also damage other rapidly growing cells such as hair follicles, skin, and nails. Both treatments can cause changes in a person's skin tone and texture, as well as loss of hair. Chemotherapy drugs may change the texture of a person's fingernails.

Although taking care of how you look while also undergoing treatment for cancer may be the last on a patient's list of things to do, Nicholas believes it is important for a lot of people.

“When you're diagnosed, you're ravaged with ten thousand thoughts and this could be the last thing you think about. But, this is one area that you can take control of. Maybe you feel horrible but you look like yourself and that can allow you to maintain some level of normalcy,” Nicholas said.

Dr. Robert Buckman, oncologist and author of What You Really Need To Know About Cancer , believes improving or maintaining physical appearance during cancer treatment can be of psychological benefit for patients.

“First of all, there is absolutely no doubt that the way we appear to the outside world influences the way people respond to us. And that influences the way we feel about ourselves,” Buckman said.

He advised, “Don't create a total and false façade, but as you begin to feel better, make yourself look a bit better and by other people's responses to you, you will feel a little better still.”

Echoing Nicholas, Buckman said, “And of course, the control aspect is essential. We all, when we're sick, have to try and find something that we can control. At our worst, it may be no more than the remote control for the television set, but that's still something.”

Skin Health Tips for Cancer Patients

According to Nicholas, the effects of chemotherapy on a person's skin are “as individual as the person.” However, he said some common side effects include “an obvious sallowness in the skin, some blotchiness, gray undertones, and just a general look of illness.” Radiation, Nicholas noted, can cause “more of the ruddy, blotchy activity in the skin.” The effects of both treatments depend on “the person, the amount of therapy, and the length of treatment.”

For people who have skin damage due to any of these treatments, or who are preparing for treatment and want to know what they can do for their skin, Nicholas recommends a few tactics.

“If they know that they're going in for treatment, I would definitely recommend that they seek out a makeup artist professional, someone who deals with more medical conditions,” he said. Hospitals may have information on local makeup artist professionals who have experience in dealing with cancer patients.

Nicholas, who has been volunteering his time to cancer patients and others with special skin needs for decades, said many makeup artists volunteer their services to people living with cancer who may not be able to afford the consultations and care.

“A wealthy cancer patient can afford this and can get the best treatment and care on the cosmetic end. For those who can't, there are people who will do it on a volunteer basis. There are organizations all over that assist and help and guide. Social services at a hospital should be able to help you find someone,” Nicholas said.

The American Cancer Society sponsors the Look Good, Feel Better program, which is available at many hospitals or local American Cancer Society chapters.

Nicholas recommends that cancer patients see a makeup artist or esthetician prior to starting their treatment, if they can. This way, he said, the professional can discuss the person's current skin-care regime and see what their skin is like when they are not undergoing treatment. Patients can also bring pictures of themselves before they started treatment to their first appointment.

For those who cannot afford or do not have access to a professional makeup artist or esthetician, Nicholas said there are things a person can do at home for fairly little money. In general, he recommends that all people, especially those going through treatments for cancer, develop what he calls “a proper skin regime.”

“What's worked for you all along should work now, but you should be faithful and maybe a bit gentler,” Nicholas noted. “You might want to do something a bit more calming and put aside anything harsh.”

“Harsh” products, according to Nicholas, include those with abrasive ingredients, such as certain scrubs meant to exfoliate the skin. He also recommends staying away from products with alpha hydroxy acids while undergoing cancer treatments. In addition, Nicholas strongly recommends staying out of the sun.

“The proper calming regime for your skin includes a cleanser, toner, and moisturizer,” he said. “This is a simple three-step regime that is going to help maintain skin health without being radical.”

Other “must-have” items include “the proper concealment,” which Nicholas said can be a foundation, a powder, or a foundation stick, depending on the person's needs.

A professionally-trained makeup artist can work with a patient to determine which products would be best for their skin as well as which colors would work. For those who are not able to meet with a professional, Nicholas advised sticking to neutral and natural shades, such as browns and cremes, rather than using really colorful shades, which are less natural-looking.

“Your blush tones might change depending on changes in your color. With shadows, stick to more neutral shades. Neutrals look more natural. To create the illusion of depth and natural tones, natural shades of eye shadow are preferable,” Nicholas said.

As an extra precaution, Nicholas said cancer patients can tell their doctor what skin products they are using or make a list of the ingredients in those products and show the list to their doctor to make sure they are healthy for their skin.

Buckman agreed that it is essential for patients undergoing radiation to tell their radiation oncologist what they are putting on their skin. “From the medical point of view,” he said, “the only important thing is if you are having radiotherapy and you're putting local skin treatments on an area of skin that is having radiotherapy. Make sure you tell your radiation oncologist.”

Nail Care

To care for fingernails, which may change texture during treatment, Nicholas recommends seeing a nail technician if possible. He stressed not doing anything drastic, but, rather, keeping the routine simple and easy to maintain.

“If the nails are not as strong as before or if they become brittle or have other problems, I would definitely seek out someone within that industry. Make sure it's a nail technician – someone who truly knows nail health,” he said. Nail technicians can be found at many salons or beauty parlors.

For those who cannot visit a nail technician, it is a good idea to keep nails fairly shorter and well shaped, keep the cuticles well trimmed, and the hands moisturized. A clear coat of nail polish, applied regularly, helps to keep nails strong.

Countering Hair Loss

Hair loss, which is a side effect of chemotherapy and radiation to the head, can be upsetting for a cancer patient. However, a person with hair loss has options - hair replacements (commonly known as wigs), scarves, and turbans. And there is always the option of using nothing.

Hair Replacements

There are three types of hair replacements. These include wigs made of human hair, those made of a combination of human hair and synthetic material, and synthetic hair replacements. Each has its own benefits and disadvantages.

Human hair wigs, Nicholas said, are the most natural looking. They are also the most expensive and require the most maintenance. “With human hair wigs, you have to wash them and dry them and really care for them,” he noted, adding that the additional care that goes into these wigs may be too much for someone going through treatment.

“I would not advise these for cancer patients unless you have the money and are really looking for authenticity. Typically, the wigs for cancer patients are going to be temporary because your hair is going to grow back after treatment. My theory is, ‘Why invest the money when it's a temporary situation?'” Nicholas said. In some cases, such as radiation to the head, hair loss may be permanent.

He continued, “Synthetics are the cheapest. The problem is that they look artificial and the sheen can be unnatural, but synthetics have come a long way. They are affordable and manageable. They hold their shape and style forever.”

Nicholas said that synthetic wigs can be found for as little as $30. In addition, they require very little maintenance.

The ideal wig, according to Nicholas, is the blend of human and synthetic hair. “The blend is the best because the human aspect gives it the realism in quality, while the synthetic aspect will allow it to hold its style without too much care,” he said.

Just as Nicholas recommends patients see a makeup artist before they begin treatment, he suggests they visit a wig specialist before they lose their hair. Commonly, hospitals will provide referrals for cancer patients.

“Go in before you lose your hair,” he said. “Or, at least bring a photograph or a sample of your hair. This way they can match up the color and texture and then take that sample to find a good match. Most people want their hair to look like what it did before they lost it.”

He continued, “It's still best to do it before you lose your hair so that way, when your hair does fall out, you don't have to leave your home feeling vulnerable. Again, you're in control.” Seeing a wig specialist prior to treatment also gives the patient a chance to try a variety of wigs on and not feel rushed to make a decision. In addition, there is more time to adjust to the wig.

For those who want to change their hairstyle completely, Nicholas believes hair loss can also be an opportunity. “I would suggest that patient treat this (hair loss) as lightly as possible. Maybe you often wanted to know what you'd look like as a red head or a brunette. Invest in two or three wigs if you can. Maybe you've wanted to see what you look like with long hair or short hair. Here's your chance.”

A wig specialist will also be able to teach a patient about wig caps. Wig caps are made of sensitive material that protects the scalp. They may also help keep a wig in place.

Scarves and Turbans

“The scalp can get very sensitive and sometimes a wig can be painful to wear,” Nicholas noted. “Remember, there are hats and turbans and scarves these days. The scarf has made a major fashion comeback.”

Cancer patients can ask their nurses or other healthcare team members if they have information on how to tie scarves or where to buy stylish hats. A makeup artist or wig specialist may also provide advice on scarf tying.

Choosing to Go Bare

Some people with cancer may choose to wear nothing at all when they lose their hair. For these patients, Nicholas recommends extra care of the exposed scalp. “You wouldn't shampoo it. I would suggest that you use the cleanser you use on your face. If there is some remaining hair but it's thin, shampoo those areas with a mild shampoo that doesn't irritate,” he said.

Eyebrow Care

Total or partial hair loss may also occur in the eyebrow and eyelash area. Nicholas suggests seeking the help of a professional makeup artist or esthetician to create the look of natural eyebrows and lashes.

“In the lash and brow area, I would say it's really ideal to get instructions,” Nicholas said. “This is a technique. It's not something where you can walk up to any makeup counter and say, ‘I have no eyebrows. Can you help me?'”

Nicholas' technique for applying eyebrows for someone who has none is to alternate the use of powders and pencils. He has created a series of eyebrow stencils to make the process easier. The stencils are available on his website.

“The eyebrows seem to be a big concern for a lot of people,” he said, noting that a visit to a makeup artist or esthetician before treatment is ideal so the professional can see the original eyebrows.

Looking and Feeling Your Best

Nicholas believes cancer patients can benefit from taking all the control they can. He said, “Medically you might not have too much control. But, taking on this concern may actually make you feel like you have hold of an issue. If you tend to feel worse because of your appearance, it may help you even more. I've seen patients who look better through their treatments than they ever have.”

The American Cancer Society offers a "Look Good Feel Better" program in many areas. These helpful workshops teach you how to use cosmetics, scarves, and wigs. Call your local ACS office for more information.